Balloon Kyphoplasty for Spinal Compression Fracture

I got this alert last night, and it may apply to myeloma patients who have had spinal compression fractures.

Balloon Kyphoplasty for Spinal Compression Fracture

At 1 month, kyphoplasty patients had significantly greater improvements in global quality of life, back pain, and function than did controls.

In vertebroplasty and kyphoplasty, two minimally invasive procedures for spinal compression fractures, cement is injected into damaged vertebrae to prevent further compression and to alleviate pain. In kyphoplasty, a balloon is inflated within the vertebra to restore normal height and shape, and cement is injected into the resulting cavity. Although both procedures have been in use for longer than a decade, few data support long-term safety and efficacy of either one. With funding from a kyphoplasty instrument manufacturer, researchers randomized 300 patients with one to three acute vertebral compression fractures (average duration, 6 weeks) to receive supportive care alone or supportive care plus balloon-assisted kyphoplasty.

When the groups were compared after 1 month of follow-up, kyphoplasty patients had significantly greater improvements in global quality of life, back pain, and function and reported significantly fewer days of restricted activity. During the next year, these differences between groups narrowed, with some (but not all) losing statistical significance. Adverse events were similar in the two groups, apart from two reversible perioperative complications and a nonsignificant trend toward more new vertebral fractures in the kyphoplasty group.

Comment: This nonblinded study provides additional evidence that kyphoplasty improves symptoms and function more rapidly than supportive management. Although short-term pain relief and earlier resumption of normal activities are important outcomes, more data on the long-term efficacy and safety of the procedure are needed. The authors of the current trial will collect another year of follow-up data, and other groups are conducting randomized studies to compare vertebroplasty to kyphoplasty or to sham procedures.

— Bruce Soloway, MD

Published in Journal Watch General Medicine April 7, 2009

Citations:
Wardlaw D et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): A randomised controlled trial. Lancet 2009 Mar 21; 373:1016. [Medline® Abstract]

Kallmes DF and Jarvik JG. Spinal augmentation research: FREE at last? Lancet 2009 Mar 21; 373:982. [Medline® Abstract]

Copyright © 2009. Massachusetts Medical Society. All rights reserved.

The above message comes from “Journal Watch”, who is solely responsible for its content.

10 Comments

  1. Jean-Luc Neptune

    Hi Beth – Very interesting to hear that you receive alerts from Center Watch. Do you subscribe to the full newsletter? Do you subscribe to any other medical publications like the New England Journal of Medicine? I’m convinced that more and more people who aren’t health professionals (I’m an MD) are using medical journals to improve the overall quality of their health. Do you find the information useful? Do you end up discussing what you read with your doctor? I would love to learn more about how you’re using this great information.

    • Beth

      I get the notices from Epocrates, which I have on my iPhone. There’s a great free version that I’ve found to be really useful. I subscribe to OncologyStat and Google alerts for topics of interest. I have a little trouble reading medical journals if they’re too sciency.

  2. LaCootina

    I had kyphoplasty on my two most-damaged vertebrae in February 2009. My surgeon hd performed 100+ of this specific surgery. The surgery itself was less than two hours, the two tiny incisions caused no pain or problems. The anesthesia probably required more recovery than the surgery. There was immediate, significant improvement! After about a month or so, though, much of the pain came back. Maybe the original area, maybe just continued disintegration of my spine. BUT… I would still do it again in a hearbeat if they felt there was a chance for further improvement. And I would recommend it to anyone considering it if they meet the criteria, and have confidence in their surgeon.

    (P.S. Got the exact same charming, personal comment from Dennis.)

    • L.P. Cells

      I likewise had a similar experience but without the recurring pain. The procedure was a breeze. I only had one ‘infested’ vertebrae, T10.

  3. Beth

    Oh, good grief! I hate spam comments. I can usually spot them. I’m going to dispose of it. :)

    I’ve been lucky not to have had any bone trouble with my myeloma. I have one of the varieties that likes to produce a lot of proteins. I’m glad to know that the kypho is a good option if it’s needed.

  4. HurtingStill

    I had the surgery about 3 weeks ago. They did two vertabrae so I had four small holes in my back. I have not noticed much if any improvement and I’m still in a lot of back pain. If you have had this surgery and feel better or worse please let me know. Is it too soon for me to judge? Can I expect less pain? If this is as good as it gets after kyphoplasty surgery?

    • Teresa

      I had this same surgery which was 2 weeks ago today. As of the way I have felt since surgery I would never do it again. I have hurt worse twice as worse as I did before the surgery. They are doing some test now to see if some of the cement has leaked out into a bad spot, in which if it has will require more surgery.

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